Slow Weight Loss? Do this: Part 2
When tracking doesn't work.
In the first part of this series, we talked about the pros and cons of tracking your nutrition.
But what happens when that doesn’t work?
What if you’ve tried macro tracking for weeks, months, or years, and still aren’t seeing progress?
What if you’ve tried tracking, but have a difficult time consistently achieving a calorie deficit?
What if you absolutely can’t stand the idea of tracking, it doesn’t fit into your lifestyle, and you refuse to do it?
There are ALWAYS other options.
Show me the data
When it comes to weight loss, we need more data than just calories in vs calories out. There are hormonal, metabolic, nutritional, and emotional factors that can contribute to slower progress.
Tell me more
If you want to understand what your body is doing (or not doing) to support weight loss, here are some tests to consider.
Look At Your Metabolic Health
If you’re noticing:
More weight gain around your middle.
Frequent sugar cravings
Difficulty going longer than 2 hours without food
3 am wake-ups
Difficulty losing weight
Brain fog or difficulty concentrating
Unexplained fatigue
Irritability (month-long)
It’s a good time to check in on your blood sugar. To be fair, it’s almost always a good time to check in on your blood sugar, especially in perimenopause when estrogen begins to tank (which can impact insulin sensitivity) or if you have a history of elevated blood sugar readings.
Key tests to ask your doctor for:
Hemoglobin A1c - this highlights your average blood sugar levels over a 3-month period. It’s important to note that there are limitations to this. For example, this doesn’t highlight variability in your levels on a daily or per meal basis. High and low readings are averaged out. While it’s helpful information, it should be taken in context with other blood sugar labs.
Optimal levels are <5.5%
Fasting insulin - This isn’t on a standard lab panel. You can always order it yourself, push back on your doc to order it, or work with a more integrative/functional provider who sees the value.
Optimal levels are between 2-6 uIU/mL
Fasting glucose - This one is more commonly checked and easy to get.
While some guidelines suggest you’re “normal” if you’re under 100 mg/dL, a tighter/more optimal range is <90. If you can aim for between 80-86 mg/dL, it’s worth a shot!
Other markers:
Glucose levels should be between 70-120 mg/dL for approx 90% of the day
Aim for <30 mg/dL increase after meals
If you have the budget for it, I highly recommend using a CGM. Two options that do not require a prescription:
Stelo or Lingo - these are cheaper options (~$50), but the app offers fewer features and limited interpretation. These can work well if you’re more advanced in your understanding of health/nutrition.
Levels - I’ve been using Levels for years, since their app provides a ton of bonus information and features (like macro tracking) you won’t get from the options above. This is a better option for those who are looking for more support with understanding the data.
Insulin resistance creates an environment where your body is programmed to store fat and resist weight loss, all while impacting your sleep, cravings, and inflammation. Improving insulin sensitivity—through diet, exercise, and sometimes medication—can dramatically improve weight loss outcomes.
Look At Your Thyroid Health
If you’re noticing:
Unexplained weight gain
Cold intolerance
Dry skin
Brittle nails
Constipation
Depression or low mood
Hair loss or thinning
Heavy periods
Brain fog or difficulty concentrating
When you’re a woman, it’s almost always a good time to check in on your thyroid. This is especially true after having a baby and in perimenopause when hormone fluctuations and (likely) years of chronic stress have taken a toll.
Key tests to ask your doctor for:
TSH - Signals the thyroid to produce more thyroid hormone.
Standard lab range: ~0.4–4.5 mIU/L
Functional/optimal range: 1.0–2.0 mIU/L
A TSH in the upper-normal range (e.g. 2.5 - 4.0) might still signal early thyroid dysfunction, especially with symptoms.
While not the standard of care, thyroid medication may be beneficial if you have a level over 2.5 and low-normal Free T3, with symptoms.
Free T3 - The active form of thyroid hormone that impacts metabolism and energy.
Standard lab range: ~2.3–4.2 pg/mL
Functional range: 3.2–4.5 pg/mL
You can have “normal” TSH and Free T4, but if Free T3 is low, you may still have symptoms like fatigue or weight gain.
Free T4 - The storage form of thyroid hormone; must convert to T3 to be active.
Standard lab range: ~0.8–1.8 ng/dL
Functional range: 1.2–1.5 ng/dL
Reverse T3 - The form that blocks active T3 from entering receptors. High rT3 can occur during stress, illness, or calorie restriction, reducing thyroid activity.
Functional range: Below 15 ng/dL
Free T3 : Reverse T3 ratio > 2:1
Thyroid Antibodies (TPO, TG) - These assess autoimmune thyroid disease, which may occur years before you notice a change in your TSH level.
Functional goal: As low as possible; ideally undetectable.
TPO - less than 34 IU/ml, ideally under 14 IU/mL
If you’re doing “everything right” but not losing weight—or even gaining—it’s absolutely worth checking your full thyroid panel and comparing it to optimal levels, not just “normal” ones. Supporting thyroid health can unlock weight loss that feels impossible otherwise.
Look At Your Hormonal Health
We can’t talk about weight loss and vitality without questioning hormonal factors, including estrogen, progesterone, and testosterone.
High Estrogen Symptoms (with or without low progesterone):
Weight gain, especially hips/thighs or abdomen
Breast tenderness or fibrocystic breasts
Heavy, painful, or prolonged periods
PMS, irritability, or mood swings
Bloating and water retention
Headaches or migraines (especially around menstruation)
Fatigue
Difficulty losing weight
Low Progesterone Symptoms:
Anxiety or restlessness, especially at night
Insomnia or trouble staying asleep
Shortened or irregular cycles
Spotting before periods
PMS (mood swings, irritability, depression)
Breast tenderness
Headaches
Difficulty handling stress
Low Testosterone Symptoms:
Low libido or sexual satisfaction
Low motivation or drive
Fatigue, especially physical
Loss of muscle tone or strength
Increased body fat (especially belly)
Brain fog or low confidence
Bone loss (osteopenia/osteoporosis)
Key tests to ask your doctor for:
Estradiol (E2)
Progesterone (mid-luteal phase, ~day 19-21)
Free and Total Testosterone
DHEA-S
SHBG (Sex Hormone Binding Globulin)
LH/FSH ratio (especially if PCOS is suspected)
The ranges vary based on where you’re at in your cycle, so we can get into that in another Substack.
For now, know that if progesterone is low and estrogen is still moderate, this = estrogen dominance. This leads to mood swings, PMS, and weight gain. If you’re noticing signs of low progesterone and you’re 35+ , it’s worth considering progesterone supplementation. I’ll share an entire blog about this soon!
Look At Your Gut Health
Besides the obvious (bloating and water retention), the health of your gut can impact your weight loss efforts.
Here’s why:
Microbiome composition:
Certain bacterial species are more efficient at extracting energy from food, contributing to weight gain.
People with obesity often have different microbiome compositions compared to those of a healthy weight.
Appetite:
Your gut bacteria influence hormones like ghrelin (hunger hormone) and leptin (satiety hormone), affecting how hungry or full you feel.
Inflammation:
Conditions like IBS/IBD and chronic stress impact systemic inflammation, which is linked to insulin resistance and fat storage.
A high-fat, low-fiber diet can add to the inflammation.
Cravings:
Overgrowth of certain yeast, such as Candida, can trigger cravings for sugar, as that feeds the yeast.
While we’re still working to better understand this, I wouldn’t be surprised if we find that some individuals experience GLP-1 resistance, which makes it harder for them to shut down the food noise and stick to a deficit.
Key tests to ask your doctor for:
Comprehensive stool tests (like GI-Map, Doctors Data, or GI Effects)
Checks for:
Gut microbiome diversity and balance (good vs bad bacteria)
Yeast or fungal overgrowth (like Candida)
Parasites
Digestive function (elastase, fat in stool)
Inflammation markers
Immune markers (secretory IgA)
Short-chain fatty acids (SCFAs)
Gut dysbiosis, Candida, or inflammation can drive systemic insulin resistance, cravings, and metabolic dysfunction.
Look At Your Stress And Sleep
Stress and sleep have a huge impact on weight loss, sometimes more than diet or exercise alone.
Here’s why:
Chronic, high cortisol can increase fat storage, especially around the stomach
Both high stress and poor sleep trigger cravings for foods higher in sugar
Poor sleep impacts leptin and ghrelin, which are hunger/satiety hormones
Cortisol interferes with thyroid function, T4 to T3 conversion, thereby slowing metabolism
Just 1–2 nights of poor sleep can impact insulin sensitivity, making fat burning harder
Stress disrupts neurotransmitters like serotonin and dopamine, increasing appetite and impulsive eating
Chronic stress impacts hormone levels like progesterone and calming neurotransmitters
Key tests to ask your doctor for:
Cortisol Testing (Saliva or Dried Urine)
4-point Cortisol Test (morning, noon, evening, night)
Measures your cortisol rhythm (should peak in AM, taper at night)
Can be done via saliva (e.g., ZRT Labs, Dutch Complete dried urine)
DHEA
Low DHEA with high cortisol suggests adrenal imbalance (high stress)
HRV (Heart Rate Variability)
Wearables like Oura, WHOOP, and the Apple watch track sleep and stress.
Low HRV = higher stress burden, lower recovery capacity.
While there are other factors (like nutritional deficiencies + heavy metals) that can make weight loss resistance more difficult, these hormonal and gut related factors play the strongest role.
Now what
We just went over a ton of tests, it can be overwhelming to know where to start.
It can also be expensive to order all the tests on this list or find a practitioner to work with you.
So here’s what I’d do:
Identify your suspicions. Are you 35+ and navigating a handful of the symptoms of low progesterone and thyroid imbalance? Start there. Do you have a crazy work schedule and don’t get enough sleep? Start with stress or sleep.
Do what you can. Maybe you don’t have the finances for functional tests, but you can order conventional ones to understand where to start. Nail that first.
Give yourself grace. Now you see how intricate and complicated weight loss is. You can remove any shame or guilt about why it’s so hard.
Now I want to hear from YOU. Where are you going to start?